The goal of my last post was to make the case for hospital hourly rounding as a strategy for increasing patient and staff satisfaction, reducing patient injuries, saving nursing time, and saving hospitals significant amounts of money. Over the next few posts, I'll discuss the biggest challenges hospitals typically encounter when they attempt to put an hourly rounding program in place.
Of course implementing any organization-wide program is difficult, because these types of efforts require training a large cross-section of staff and providing support and follow-up to be certain that the change occurs. And implementing hourly rounding is even more challenging than many other changes because it affects the basic workflow of nursing. Through much study of these challenges and many discussions with nurse leaders, I've found that the primary challenges to successful hourly rounding programs can be grouped into these areas:
- Sustaining the process
- Using outputs from the process to make meaningful improvements in patient care
Effective communication about the new hourly rounding process is critical, including thorough discussions around the expected benefits for patients, families, and staff. Nurses need to understand both why they are being asked to change their daily processes and how to integrate hourly rounding into their current workflow so that the program is not perceived as added work. As with any large-scale change, hospital leaders--and especially nurse leaders--must be fully committed to the change and must express their commitment through their involvement in the communication efforts.
The most powerful way that nurse leaders can communicate the importance of hourly rounds is to conduct their own daily patient rounds. Through daily patient rounds, nurse leaders verify that hourly rounding is occurring through both discussions with the patients about hourly rounds and by ensuring that the care boards reflect that hourly rounds have occurred. In addition to reinforcing with staff nurses that patient rounds are essential, daily patient rounds enable nurse leaders to identify staff who deserve recognition for exceptional performance, as well as those that may need additional coaching.
A comprehensive automated rounding solution, such as the iRound Patient Satisfaction Solution, which includes a mobile data collection tool that can automatically populate interactive dashboard-style reports, as well as services that support sustained improvement, can help hospitals ensure that the right communication is happening on an ongoing basis. iRound PSS tracks rates of direct report rounding, nurse leader and executive rounding, and recognition on dashboard reports--all automatically and without requiring any transcription or consolidation of data. Not only do these reports track rounding activity, but they can also help demonstrate to staff exactly how their efforts in hourly rounding are affecting patient care outcomes, which can be a critical aspect of fostering ongoing support for the program.
Tracking and reporting on nurse leader rounds is essential for demonstrating rounding compliance, identifying recurring performance issues or trends, and managing follow-up. Unfortunately, tracking nurse leader rounds on paper (or even using a workstation-on-wheels application) is difficult to the point of being unworkable. The added effort of managing the paper, transcribing the data, and creating rounding reports is simply not feasible in most hospital units. In fact, when rounding programs fail—or fail to demonstrate results—the most common cause is the hospital's inability to systematically track and report on daily rounds (which verify that hourly rounding is occurring).
With iRound PSS, each round is conducted using an iPad, iPod touch, or iPhone, which takes less than a minute, on average. Each round is automatically recorded, with no additional data entry or transcription time required and no need to compile and format data in Excel or other tools to create reports. It's easy for nurse leaders to change which questions are displayed on any iRound form, so valuable insight into the patient experience can be gathered during nurse leader rounding to support patient care excellence. If a change has been made within one unit or on one floor based on patient input, for example, nurse leaders may easily add a question that only displays for rounders in that area, enabling the change to be tested and improvement verified.
This puts control of the rounding program into the hands of nurse leaders, while eliminating such non-value-added activities as data transcription, proofreading, and report creation. It similarly simplifies direct report rounding, recognition, service recovery issue management, and many other aspects of a rounding program.
Next time, I'll take a look at some other typical challenges and discuss how automation can help hospitals overcome them.